摘要
本研究探讨异基因造血干细胞移植治疗慢性粒单核细胞白血病(CMML)及幼年粒单核细胞型白血病(JMML)的疗效及其影响因素。对3例CMML及2例JMML患者接受异基因造血干细胞移植治疗的临床资料进行多参数分析。结果表明,造血干细胞在5例患者中均成功植入,除1例JMML死于移植后并发症外,余4例至今无病生存。移植前疾病负荷、染色体核型及II-IV度aGVHD的发生均对CMML的复发率或无病生存率有相关的影响;低剂量预处理方案优于清髓性预处理方案,而HLA的相合度及干细胞的来源均不影响总的生存率及无复发生存率,在JMML患者中脐带血造血干细胞移植的移植失败率明显高于骨髓或外周血造血干细胞移植;移植前脾脏的大小及是否行脾切除或者脾区照射对移植结果无影响,而移植年龄、GVHD的发生及HbF的水平对移植复发率均有重要意义。结论:异基因骨髓造血干细胞是治疗CMML及JMML的有效方法,但仍存在一系列问题需要解决。
This study was purposed to explore the therapentic efficacy and influencing factors of allogeneic hematopoietic stem cell transplantation（allo-HSCT） in patients with chronic myelomonocytic leukemia（CMML） and in patients with juvenile myelomonocytic leukemia （JMML）. The clinical data of 3 cases of CMML and 2 cases of JMML underwent allo-HSCT were analysed in term of multiparameter. The results showed that the hematopoictic stem cells in 5 patients grafted successfuly. One case of JMML died of pulmenary disease, other 4 cases survive without disease. The analysis found that the disease burden before transplant, chromosome karyotype, acute GVHD II - IV and poor risk cytogenetics all associated with the relapse rate and disease-free survival rate of CMML. The low intensity conditioning ragimen was better than myeloablative conditioning regimen. Type of donor and source of stem cells did not statistically and significantly affect OS and RFS. The splenectomy before allo-HSCT as well as spleen size at time of the alloHSCT did not influence on posttransplantation outcome of JMML. However, cord blood HSCT for JMML patients delayed hematologic recovery as compared to that of bone marrow or peripheral blood HSCT. The age, GVHD, HbF level played an important rale in leukemia resplase. It is concluded that the allogeneic hematopoietic stem cell transplantation is a curative regimen for CMML and JMML, but there also is a serial problems to be resolved.
出处
《中国实验血液学杂志》
CAS
CSCD
北大核心
2014年第4期1058-1062,共5页
Journal of Experimental Hematology
